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Declaration of Domicile and Citizenship -
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TO T'l~ CLERK OF TtIE (~ACI)IT OOURT.. - - -
ST. LUG 1 E OOUt+I'1'Y, Pi,O~tIDA: - -
This is nq? declaration d DomkDe and Qitiaenahip is the State d Florida that I;am ~g thia dy is aoeordaoee, and is
ooafarmi4T Frith Section 223.17. Floti~? Statutes.
~ I was kEat resident d ',~i4 L ?Eie~ _ _ A ~ and I .
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resided at ~ V"~%~ PNvd" - 8ow~rer. I haw changed tu7 damians ~
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sod am and haw bees a bona Sde sasjdent d the State d Florida sines ~ ~ ~ dsT d ~ -
~ R ~ - 1~ (J.., aad I reside at ~ ~3 O•P~ ~ -1 - -
~<w..~..aH..e.~l
. : ^ L. - !/C E- - ST. L UG I E - Conat~. Florida.
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snd this ststenxnt is to be ta>tea as aoT dedsrstion d dtisenship. setual-kEal raider ~ and domicils is the 8tah d b'loeida. - ~ -
If FOR THE PURPOSE OF E.NROILiNG - IF. fOR -HOMESTEAD PURPOSESs
CHIIDREN IN SCHOOLS P~EASE`STATE RL-ELSE-CHECK:
THEIR NAMES:
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_ - ~ _ 1~0 JAN 31 PII 38 .
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~~ANQ PEC
_ CLERK Cq~dM7
_ _ IIECpitsYl:R<~IEQ -
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I F[JATHER CEAT>P"li that I wiD register at n~p local sddras whoa the reaidrrti~on boob reopen, and ~7 with all
~ other ssgniremeats d a legal reddeM d this Sts~e. - i
I FURTIi1~t (~RTIP'Y that I haw no intsntioa to return to farmer domidle. and I intend to remaia in
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3wacn to ms this 3! dq d - U 'f lfEi/~ rL 3.3 ~
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A.D. i~~ - ~'o29A ~AKel~is
Cays~l~
ROGER POI TRAS. CLERK OF GIRCUI T CQt~I2T
ST. LtlG I E COUNTYs FLOR 1 OA -
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- BYs ~'nZwe..l.~i.~,. - -
EPUTY LERK _ - I'~~~ -
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